Hospital clinicians information behaviour and attitudes towards the 'Clinical Informationist': an Irish survey

Background: Hospital clinicians are increasingly expected to practice evidence-based medicine (EBM) in order to minimize medical errors and ensure quality patient care, but experience obstacles to information-seeking. The introduction of a Clinical Informationist (CI) is explored as a possible solution. Aims:  This paper investigates the self-perceived information needs, behaviour and skill levels of clinicians in two Irish public hospitals. It also explores clinicians perceptions and attitudes to the introduction of a CI into their clinical teams. Methods: A questionnaire survey approach was utilised for this study, with 22 clinicians in two hospitals. Data analysis was conducted using descriptive statistics. Results: Analysis showed that clinicians experience diverse information needs for patient care, and that barriers such as time constraints and insufficient access to resources hinder their information-seeking. Findings also showed that clinicians struggle to fit information-seeking into their working day, regularly seeking to answer patient-related queries outside of working hours. Attitudes towards the concept of a CI were predominantly positive. Conclusion: This paper highlights the factors that characterise and limit hospital clinicians information-seeking, and suggests the CI as a potentially useful addition to the clinical team, to help them to resolve their information needs for patient care

Patients' perceived health service needs for osteoarthritis (OA) care: a scoping systematic review

OBJECTIVE: To identify and synthesise evidence regarding patients' perceived health service needs related to osteoarthritis (OA). DESIGN: A comprehensive systematic scoping review of MEDLINE, PsycINFO, EMBASE and CINAHL (1990-2016) was performed to capture information regarding patient perceived health service needs related to OA. Risk of bias and quality of included articles were assessed. Relevant data were extracted and collated to provide a systematic review of the existing literature. RESULTS: Of the 1384 identified manuscripts, 21 were relevant to areas of patient perceived need, including needs related to medical care, pharmacologic therapy, physiotherapy and exercise therapy and alternative medicine. Key findings included (1) Symptom control drove the need for both conventional and complementary services. (2) An individualized relationship was sought with a practitioner knowledgeable in OA care and who adopted a holistic approach, whether providing conventional or alternative therapies. (3) Medications were required to obtain symptomatic relief, with use tempered by recognition of potential side effects and financial cost. (4) The need for allied health services was recognised, although patient and system issues were barriers to uptake. (5) Patient's attitudes towards joint replacement, orthoses and physical aids were influenced by patient preferences and previous healthcare experiences. CONCLUSION: Patient perceived needs are similar to those suggested by clinical guideline recommendations. Better aligning patient perceived needs with healthcare requirements may improve OA outcomes and optimise healthcare system utilisation

Patients’ informational needs while undergoing brachytherapy for cervical cancer

Published ArticleTo identify informational needs of South African women receiving intracavitary brachytherapy for locally advanced cervical cancer as part of a process to develop guidelines for quality patient-centred care. Design: A prospective, qualitative study with a phenomenological approach. Setting: Brachytherapy Unit, Department Oncology, Universitas Hospital, Bloemfontein, South Africa. Participants: Purposive sampling was utilized to recruit patients undergoing brachytherapy for cervical cancer from July to December 2012. Main Outcome Measures: Semi-structured, one-to-one interviews were conducted, guided by a theme list. Audio-recorded interviews were conducted in Sesotho, Afrikaans and English by an unaffiliated, multilingual interviewer. The interviews were transcribed, translated and thematic analysis performed. Results: Data saturation was achieved having interviewed 28 participants, aged 30–73 years. Four themes with sub-themes were identified: (i) informational needs, (ii) patient disposition towards treatment, (iii) psychological experience and (iv) physical experience. Findings on patients’ informational needs were the overarching theme and form the focus of this article. These informational needs included: providing patients with disease- and treatment-related information in their home language; adequate information concerning possible side-effects, sexual intercourse and pre-treatment preparation; and providing patients with informative material as standard procedure. Conclusion: The article has identified women’s informational needs providing a focus for patientcentred care. Providing patients with sufficient and understandable information could lessen feelings of fear and anxiety towards treatment delivery. Guidelines with a patient-centred approach could thus be developed to be used as a tool to assist members of multidisciplinary teams in providing quality care to this group of women

What patients think about choice in healthcare? A study on primary care services in Finland

Background: The ongoing Finnish health and social service reform will expand choice by opening the market for competition between public and private service providers. This study examined the attitudes of primary care patients towards choice and which patient-related factors are associated with these attitudes. Methods: A sample of attenders during one week in health centres of 12 big cities and municipal consortiums (including seven outsourced local units) and in primary care units of one private company providing outsourced services for municipalities (aged 18-95, n=8128) was used. The questionnaire included questions on choice-related attitudes, sociodemographic factors, health status, use of health services and patient satisfaction. Results: Of the responders, 77% regarded choice to be important, 49% perceived genuine opportunities to make choices and 35% were satisfied with the choice-relevant information. Higher age, low education, having a chronic illness, frequent use of services, having a personal physician and being satisfied with the physician and with waiting times were related to assigning more importance on choice. Younger patients, those with higher education as well as those with chronic illness regarded their opportunities of choosing the service provider and availability of choice-relevant information poorer. Conclusions: The Finnish primary care patients value choice, but they are critical of the availability of choice-relevant information. Choices of patients with complex health care needs should be supported by developing integrated care alternatives and by increasing the availability of information on existing care alternatives to meet their needs.Peer reviewe

A survey of patient informational preferences when choosing between medical and surgical therapy for ulcerative colitis:a sub‐study from the DISCUSS project

Aim: People living with ulcerative colitis (UC) have two broad treatment avenues, namely medical or surgical therapy. The choice between these can depend on patient preference as well as the receipt of relevant information. The aim of this study was to define the informational needs of patients with UC.Method: A postal survey was designed to capture respondent demographics, treatment experienced within the previous 12 months and informational preferences by rating a long list of items. It was delivered through two hospitals that provide tertiary inflammatory bowel disease services. Descriptive analyses were performed to describe demographics and experiences. Principal component analysis was carried out using a varimax rotation to investigate informational needs.Results: A total of 101 responses were returned (20.1% response rate). The median age of respondents was 45 years and the median time since diagnosis was 10 years. Control preferences skewed towards shared (42.6%) or patient-led but clinician-informed (35.6%). Decision regret was low for the population (median 12.5/100, range 0–100). Key informational needs related to medical therapy were benefits and risks of long-term therapy, burden of hospital attendance, reproductive health, need for steroid treatment and impact on personal life. For surgery, these were stoma information, effect on daily life, effect on sexual and reproductive health, risks and benefits and disruption of life due to surgery.Conclusion: This study has identified key areas for discussion when counselling patients about treatment decisions around medical therapy and surgery for UC

Evidence-based clinical knowledge assistance towards supplementing patient referral letters for evidence informed decision making

Referral letters are common means by which healthcare practitioners exchange information relevant to patient care. It has been argued that information contained in letters of referral and reply often does not meet the information needs of letter receipting.GPs (general practitioners) and specialist require knowledge and information at point of care that is related to patient specification to narrow the information gap and to assist towards better interpretation of referral letters.Given this problem at hand we present, in this paper ECKA (Evidence based clinical knowledge assistance) framework that provides evidence based clinical knowledge assistance from clinical practice guidelines and medical explicit knowledge in terms of medical literature from Medline/Pubmed pertaining to referral letter.This will help narrow the information gap at point of care and to provide better interpretation of referral letters

A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

BACKGROUND The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. METHOD We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. RESULTS Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. CONCLUSIONS In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.he Serious and Continuing Illnesses Policy and Practice Study (SCIPPS) is a National Health and Medical Council of Australia (NHMRC) funded program (no: 402793) conducted at the University of Sydney and The Australian National University and administered by the Menzies Centre for Health Policy

Early Information Access to Alleviate Emergency Department Congestion

Alleviating Emergency Department (ED) congestion results in shorter hospital stay which not only reduces the cost of medical procedure but also increase the hospital performance. Length of patient stay is used to determine the hospital performance. Organization Information Processing (OIPT) Theory is used to explain the impact of information access and availability on the information processing need and ability of a hospital. Technical devices such as RFID that works as “Auto Identification tags” is suggested to increase the information availability as well as the information processing capability of the hospitals. This study suggests that the OIPT needs to be further broken down into its entity form and then the impact of these entities is measured separately. On the other hand, institutional factors such as employee behavior towards the new technology is studied to analyze the impact of human factors in the implementation of these technical devices in the ED procedures. It can be implied from this study that early information access does increase the use of supporting EMR implementation. However, the importance of the use of EMR decreases with time on hospital performance. Moreover, other factors such as management policies related to IT positively moderates the relationship between information availability and the processing capability of a hospital ED

The psychosocial consequences of severe head injury from the perspective of relatives who care for head-injured persons in the community : a cross-sectional case study approach : a thesis presented in partial fulfilment of the requirements for the degree or Master of Arts in Psychology at Massey University

Appendix C is the best copy available.The primary aim of this research was to gain insight into the "world" of carers of head-injured persons in the community, identify their major areas of stress, and explore support needs. A cross-sectional multiple case study design was chosen. The patient sample had all experienced severe to extremely severe head injuries. They were not interviewed. Semi-structured interviews were conducted with eleven carers of the head-injured persons, all but one being a relative of the patient. A verbally-administered questionnaire was used during the interviews to ensure that standardised questions were asked of all respondents. Many of the questionnaire items were closed, but others were partially or fully open-ended. The questions addressed: historical information, changes in the patient, changes in overall life-style, changes in relationships, carers' personal and practical support needs, and their perceptions of the future. A single quantitative analogue rating scale was used to measure levels of respondents' reported distress. Respondents were encouraged to provide comments freely during the interviews. The obtained data was systematically presented in the form of group frequencies and occasional measures of central tendency. This data was supplemented by eleven individual case studies. The main patterns and themes were apparent in the grouped data, but the individual case studies permitted examination of both common and unique responses within a "real life" context. There was thus across-study and within-study investigation. The approach to the research was exploratory and descriptive. No hypotheses were held but some expectations were indicated in the existing literature. The present study found similarities with previous research in that psychosocial changes in the patient were reported more frequently by carers than broadly physical changes, reported stress levels were generally high, and there were complaints by respondents about lack of head injury information, and lack of family counselling. The most notable differences were that respondents in this study considered that (in terms of reported frequencies) communication, conversation and interactional changes in the patients, together with patients' social restrictions/isolation, were the most distressing changes for the carers. A major area of reported distress by respondents in this study related to insensitivity by others towards the patient. However, a number of positive, optimistic comments were made by respondents. Practical support needs were generally met, as were personal support needs in the form of confidantes and friends. The methodological limitations of the present study were discussed, and theoretical and practical implications examined. Suggestions were made for further research